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Maine rates for HCPCS L1920

Ankle Foot Orthosis Single Upright With Static Or Adjustable Stop (Phelps Or Perlstein Type) Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.71 / $317.73 / $317.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$465.57 / $603.17 / $1,118.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $251.34 / $251.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.11 / $246.11 / $384.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.66 / $179.66 / $246.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.83 / $423.83 / $423.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.74 / $317.73 / $317.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.10 / $327.48 / $579.85